MEDICARE: HEATHER KALE MSW, LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	27679	MN

General Provider Information

NPI Number	:	1912318742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER KALE MSW, LICSW

Provider Business Mailing Address
First Line	:	5910 SHINGLE CREEK PKWY
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-2322
Country	:	US
Telephone Number	:	763-569-5200
Fax Number	:	763-746-2401

Provider Business Practice Location Address
First Line	:	5910 SHINGLE CREEK PKWY STE 150
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-2324
Country	:	US
Telephone Number	:	763-569-5200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2014
Last Update Date	:	07/14/2020

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